Colonic perforation is a known complication of ileocolonoscopy in human medicine. Most perforations are immediately detected during endoscopy; however, up to 40% are diagnosed 24 hours post-procedure. Recent veterinary studies documented that obtaining ileal biopsies can increase the diagnostic yield of gastrointestinal [GI] endoscopy for workup of diffuse intestinal diseases; therefore, this procedure is being conducted more frequently. Currently, there are no published cases in the veterinary literature documenting iatrogenic ileocecocolic [ICC] perforations or delayed diagnosis of endoscopic perforations. The purpose of the study was to identify iatrogenic ICC perforations in dogs and cats associated with lower gastrointestinal [LGI] endoscopy, including anatomical location of perforation, timing of diagnosis, risk factors and outcome. Canine and feline medical records from two university veterinary hospitals between 2012 and 2017 were retrospectively evaluated for cases with iatrogenic ICC perforation associated with diagnostic LGI endoscopy. Cases were included if full medical records, including histopathological reports, were available. Five ICC perforations associated with canine LGI endoscopy were identified; no feline endoscopic perforations were documented. All perforations occurred adjacent to the ICC valve; two were ileal and three colonic. Three perforations were immediately identified by visualisation of abdominal contents during endoscopy, and one perforation was suspected intra-procedure due to excessive abdominal distension and confirmed with demonstration of pneumoperitoneum on plain radiographs. Pneumoperitoneum was detected on abdominal ultrasound and radiographs in one dog 5 days post-endoscopy, following evaluation for lethargy and anorexia post procedure. All dogs underwent immediate surgical correction following diagnosis of perforation, with four patients surviving beyond discharge. Histopathology from the area of perforation revealed no significant underlying pathology. The patient with delayed diagnosis of perforation died as a consequence of complications from septic peritonitis following two surgical procedures. Patient signalment, adequacy of colonic preparation and visualization, method of ileal intubation (direct intubation versus scope advancement over biopsy forceps) and underlying GI pathology did not appear to contribute to risk of iatrogenic perforation. Recent publications suggest that ileal biopsies should be obtained in all patients undergoing diagnostic LGI endoscopy; however, clinicians should be aware that iatrogenic ICC perforation can occur in canine patients with minimal underlying GI pathology. Delayed diagnosis of ICC perforation was associated with a negative outcome; if patients become unwell within the days immediately following endoscopy, perforation should be rapidly excluded with abdominal radiography to screen for pneumoperitoneum.

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